Objective
: Two extracorporeal membrane oxygenation (ECMO) circuits for children under 10 kg were evaluated and compared for plasma leakage, hemolysis, blood transfusions, and durability. Methods: ...Group A (n
= 20) was supported by ECMO circuits with the Minimax oxygenator and the Biomedicus centrifugal pump. Group B (n
= 10) was supported by ECMO circuits with the Lilliput 2 ECMO oxygenator and the Rotaflow centrifugal pump. Results: ECMO circuit durability, as measured by oxygenator lifespan, was significantly better in Group B than in Group A (p = 0.04). There was significantly lower hemolysis, measured by plasma free hemoglobin, in Group B (p
= 0.019), and patients in Group B had significantly less need for antithrombin III transfusion (p
= 0.004). No plasma leakage was observed in Group B oxygenators, but plasma leakage was observed in all Group A oxygenators. Conclusion: The combination of a Rotaflow centrifugal pump and Lilliput 2 ECMO oxygenator in pediatric ECMO circuits improved durability and reduced circuit-induced hemolysis. This improvement may be due to the low priming volume, the oxygenator's plasma leakage resistance, the suspended rotor of the centrifugal pump, or a combination of these factors.
Perfusion (2007) 22, 323—326.
THE ICELAND GREENLAND SEAS PROJECT Renfrew, I. A.; Pickart, R. S.; Våge, K. ...
Bulletin of the American Meteorological Society,
09/2019, Letnik:
100, Številka:
9
Journal Article
Recenzirano
Odprti dostop
The Iceland Greenland Seas Project (IGP) is a coordinated atmosphere–ocean research program investigating climate processes in the source region of the densest waters of the Atlantic meridional ...overturning circulation. During February and March 2018, a field campaign was executed over the Iceland and southern Greenland Seas that utilized a range of observing platforms to investigate critical processes in the region, including a research vessel, a research aircraft, moorings, sea gliders, floats, and a meteorological buoy. A remarkable feature of the field campaign was the highly coordinated deployment of the observing platforms, whereby the research vessel and aircraft tracks were planned in concert to allow simultaneous sampling of the atmosphere, the ocean, and their interactions. This joint planning was supported by tailor-made convection-permitting weather forecasts and novel diagnostics from an ensemble prediction system. The scientific aims of the IGP are to characterize the atmospheric forcing and the ocean response of coupled processes; in particular, cold-air outbreaks in the vicinity of the marginal ice zone and their triggering of oceanic heat loss, and the role of freshwater in the generation of dense water masses. The campaign observed the life cycle of a long-lasting cold-air outbreak over the Iceland Sea and the development of a cold-air outbreak over the Greenland Sea. Repeated profiling revealed the immediate impact on the ocean, while a comprehensive hydrographic survey provided a rare picture of these subpolar seas in winter. A joint atmosphere–ocean approach is also being used in the analysis phase, with coupled observational analysis and coordinated numerical modeling activities underway.
An increasing volume of prostate biopsies and a worldwide shortage of urological pathologists puts a strain on pathology departments. Additionally, the high intra-observer and inter-observer ...variability in grading can result in overtreatment and undertreatment of prostate cancer. To alleviate these problems, we aimed to develop an artificial intelligence (AI) system with clinically acceptable accuracy for prostate cancer detection, localisation, and Gleason grading.
We digitised 6682 slides from needle core biopsies from 976 randomly selected participants aged 50–69 in the Swedish prospective and population-based STHLM3 diagnostic study done between May 28, 2012, and Dec 30, 2014 (ISRCTN84445406), and another 271 from 93 men from outside the study. The resulting images were used to train deep neural networks for assessment of prostate biopsies. The networks were evaluated by predicting the presence, extent, and Gleason grade of malignant tissue for an independent test dataset comprising 1631 biopsies from 246 men from STHLM3 and an external validation dataset of 330 biopsies from 73 men. We also evaluated grading performance on 87 biopsies individually graded by 23 experienced urological pathologists from the International Society of Urological Pathology. We assessed discriminatory performance by receiver operating characteristics and tumour extent predictions by correlating predicted cancer length against measurements by the reporting pathologist. We quantified the concordance between grades assigned by the AI system and the expert urological pathologists using Cohen's kappa.
The AI achieved an area under the receiver operating characteristics curve of 0·997 (95% CI 0·994–0·999) for distinguishing between benign (n=910) and malignant (n=721) biopsy cores on the independent test dataset and 0·986 (0·972–0·996) on the external validation dataset (benign n=108, malignant n=222). The correlation between cancer length predicted by the AI and assigned by the reporting pathologist was 0·96 (95% CI 0·95–0·97) for the independent test dataset and 0·87 (0·84–0·90) for the external validation dataset. For assigning Gleason grades, the AI achieved a mean pairwise kappa of 0·62, which was within the range of the corresponding values for the expert pathologists (0·60–0·73).
An AI system can be trained to detect and grade cancer in prostate needle biopsy samples at a ranking comparable to that of international experts in prostate pathology. Clinical application could reduce pathology workload by reducing the assessment of benign biopsies and by automating the task of measuring cancer length in positive biopsy cores. An AI system with expert-level grading performance might contribute a second opinion, aid in standardising grading, and provide pathology expertise in parts of the world where it does not exist.
Swedish Research Council, Swedish Cancer Society, Swedish eScience Research Center, EIT Health.
Kidney transplantation is an essential part of care for patients with end-stage renal disease. The introduction of laparoscopic living-donor nephrectomy (LLDN) has made live donation more ...advantageous because of less postoperative pain, earlier return to normal activities, and a consequent potential to increase the pool of kidney donors. However, the cost effectiveness of LLDN remains unknown. The aim of this study was to explore the health and cost consequences of replacing open-donor nephrectomy by LLDN.
Kidney donors were randomized to laparoscopic (n=63) or open surgery (n=59). We obtained data on operating time, personnel costs, length of stay, cost of analgesic, disposable instruments and complications, and indirect costs. Quality of life was captured before the operation and at 1, 6, and 12 months postdonation by means of short form-36. The scores were translated into utilities by means of Brazier's 6D algorithm.
The cost per patient was U.S. $55,292 with laparoscopic and U.S. $29,886 with open surgery. The greatest cost difference was in costs attributed to complications (U.S. $33,162 vs. U.S. $4,573). The 1-year quality-adjusted life years (QALYs) were 0.780 and 0.765, respectively for laparoscopic and open surgery. This implies a cost of U.S. $1,693,733 per QALY at 12 months follow-up. Sensitivity analyses indicated that the cost of the major complications in the laparoscopic group and magnitude of QALY gain had the greatest impact on cost effectiveness.
The LLDN is an attractive alternative because it, in general, entails less postoperative pain than open surgery, but it is cost effective only with relatively low rates of complications.
Nuclear processing and quality control of eukaryotic RNA is mediated by the RNA exosome, which is regulated by accessory factors. However, the mechanism of exosome recruitment to its ...ribonucleoprotein (RNP) targets remains poorly understood. Here we report a physical link between the human exosome and the cap-binding complex (CBC). The CBC associates with the ARS2 protein to form CBC-ARS2 (CBCA) and then further connects, together with the ZC3H18 protein, to the nuclear exosome targeting (NEXT) complex, thus forming CBC-NEXT (CBCN). RNA immunoprecipitation using CBCN factors as well as the analysis of combinatorial depletion of CBCN and exosome components underscore the functional relevance of CBC-exosome bridging at the level of target RNA. Specifically, CBCA suppresses read-through products of several RNA families by promoting their transcriptional termination. We suggest that the RNP 5' cap links transcription termination to exosomal RNA degradation through CBCN.
We compared the survival of Helicoverpa armigera (Hübner) (Lepidoptera: Noctuidae) eggs and larvae on Bt and conventional cotton, in the presence or absence of the generalist predator, green lacewing ...larvae, Mallada signatus, (Schneider) (Neuroptera: Chrysopidae). In small arenas, green lacewings consumed a similar number of H. armigera eggs (ave. 15.8 ± 1.3 on conventional, 12.6 ± 1.4 on Bt cotton per predator over 24 h) and larvae (ave. 6.8 ± 0.7 conventional, 6.5 ± 0.8 Bt per predator over 24 h) whether on Bt or conventional cotton leaves. Likewise, similar numbers of eggs were consumed by each lacewing larva searching whole plants of either Bt (ave. 15.5 ± 0.6 of 49 over 24 h) or conventional (ave. 13.6 ± 1.1 of 49 over 24 h). On conventional plants over 72 h, survival of H. armigera larvae was 72.8% and decreased to 37.7% when lacewings were present, giving a net consumption rate of 35.1% (8.6 prey per predator over 72 h). On Bt cotton plants, 13.6% of the H. armigera larvae survived after 72 h and this decreased to 1.7% when lacewings were present. This combination of mortality factors operated synergistically. Helicoverpa armigera larvae moved to fruiting structures on conventional or Bt cotton but failed to survive in the squares (young flower buds) when the impacts of Bt and lacewings were combined. The removal of first to second instar H. armigera larvae from squares of Bt cotton by predators has the potential to reduce immediate pest damage and, perhaps more importantly, remove potentially Bt‐resistant genotypes.
We present a new solid-state NMR pulse sequence that accomplishes efficient broad-band dipolar recoupling in systems with small dipolar couplings and large chemical shift anisotropies. The method ...involves a supercycled symmetry-based recoupling sequence incorporated in a constant-interval data acquisition strategy. The supercycle removes destructive higher-order average Hamiltonian terms, and makes the method more robust at long time intervals. We demonstrate 38.4% double-quantum filtering efficiency on diammonium 1,4-
13C
2-fumarate in which the internuclear distance, as estimated by X-ray diffraction, is 387.8 pm. The estimated
13C–
13C dipolar coupling was −136.5
±
5.1 Hz, corresponding to an internuclear distance of 382.5
±
4 pm.
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